U.S. patent number 5,749,908 [Application Number 08/768,734] was granted by the patent office on 1998-05-12 for methods and apparatus for annotating data in an implantable device programmer using digitally recorded sound.
This patent grant is currently assigned to Pacesetter, Inc.. Invention is credited to Jeffery D. Snell.
United States Patent |
5,749,908 |
Snell |
May 12, 1998 |
Methods and apparatus for annotating data in an implantable device
programmer using digitally recorded sound
Abstract
Methods and apparatus are provided for annotating medical data
in an implantable device programmer using digitally recorded sound.
A display screen of the implantable device programmer preferably
displays at least a portion of a patient data set. A user
preferably designates a connection point of the patient data set.
Voice signals from the user are received by a transducer and
converted to electrical signals, which are then converted to
digital data by an analog to digital converter. The digital voice
data preferably are stored within a memory device of the
implantable device programmer and preferably are linked to the
connection point. A marker preferably is displayed on the display
screen at a location corresponding to the connection point. The
physician is able to listen to the voice annotation by selecting a
playback button displayed on the display screen. Voice annotations
preferably can be transcribed into text which preferably is
displayed in a text window when the voice annotation marker is
selected.
Inventors: |
Snell; Jeffery D. (Oak Park,
CA) |
Assignee: |
Pacesetter, Inc. (Sylmar,
CA)
|
Family
ID: |
25083341 |
Appl.
No.: |
08/768,734 |
Filed: |
December 18, 1996 |
Current U.S.
Class: |
607/30 |
Current CPC
Class: |
A61N
1/3702 (20130101); A61N 1/37247 (20130101) |
Current International
Class: |
A61N
1/37 (20060101); A61N 1/372 (20060101); A61N
1/362 (20060101); A61N 001/36 () |
Field of
Search: |
;607/30,31,32,60 |
Other References
United States Statutory Invention Registration H1347, Greeninger et
al, Aug. 1994..
|
Primary Examiner: Getzow; Scott
Claims
What is claimed is:
1. An implantable device programmer comprising:
processing means;
memory means coupled to said processing means for storing digital
data;
display means coupled to said processing means for displaying a
graphical representation of at least a part of a patient data
set;
transducing means for converting audio signals into electrical
signals; and
analog to digital converter means coupled to said processing means
and said transducing means for converting said electrical signals
into digital voice data, wherein said processing means causes said
digital voice data to be stored in said memory means and linked to
a portion of said patient data set.
2. The apparatus of claim 1, further comprising input means coupled
to said processor means for designating said portion of said
patient data set to which said digital voice data are linked.
3. The apparatus of claim 2, wherein a connection point is
designated using said input means in order to designate said
portion of said patient data set to which said digital voice data
are linked.
4. The apparatus of claim 3, wherein said processing means causes a
voice annotation marker to be displayed on said display means at a
location corresponding to said connection point.
5. The apparatus of claim 2, further comprising speaker means
coupled to said processor means for playing back said digital voice
data.
6. The apparatus of claim 5, wherein said processing means causes a
playback indicator to be displayed on said display means and causes
said digital voice data to be played back via said speaker means
when said playback indicator is selected using said input
means.
7. The apparatus of claim 2, wherein said input means comprises a
digitizer pen and said display means comprises a digitizer display
screen for transcribing said digital voice data by writing on said
digitizer display screen so as to provide transcribed digital voice
data which said processing means causes to be stored in said memory
means.
8. The apparatus of claim 2, further comprising keyboard means
coupled to said processor means for transcribing said digital voice
data so as to provide transcribed digital voice data which said
processing means causes to be stored in said memory means.
9. The apparatus of claim 8, wherein said processing means causes
said transcribed digital voice data to be linked to said portion of
said patient data set.
10. The apparatus of claim 9, wherein said processing means causes
a voice annotation marker which indicates that said digital voice
data have been transcribed to be displayed on said display means at
a location corresponding to said portion of said patient data to
which said digital voice data are linked.
11. The apparatus of claim 10, wherein said processing means causes
said transcribed digital voice data to be displayed on said display
means when said voice annotation marker is selected using said
input means.
12. The apparatus of claim 2, wherein said input means comprises a
digitizer pen.
13. An analyzer-programmer for use with an implantable cardiac
stimulating device implanted within a patient, said
analyzer-programmer comprising:
processing means;
telemetry means coupled to said processing means for receiving
information from and transmitting information to said implantable
cardiac stimulating device;
memory means coupled to said processing means for storing digital
data;
display means coupled to said processing means for displaying a
graphical representation of at least a portion of a patient data
set comprising information relating to the patient's condition
received via said telemetry means;
input means for designating a connection point of said patient data
set;
transducing means for converting audio signals into electrical
signals; and
analog to digital converter means coupled to said processing means
and said transducing means for converting said electrical signals
into digital voice data, wherein processing means causes said
digital voice data to be stored in said memory means and linked to
said connection point of said patient data set.
14. The apparatus of claim 13, wherein said information relating to
the patient's condition includes at least one of an atrial IEGM, a
ventricular IEGM and marker data.
15. The apparatus of claim 13, wherein said processing means causes
a voice annotation marker to be displayed on said display means at
a location corresponding to said connection point.
16. The apparatus of claim 15, further comprising speaker means
coupled to said processor means, wherein said processing means
causes a playback indicator to be displayed on said display means
and causes said digital voice data to be played back via said
speaker means when said playback indicator is selected using said
input means.
17. The apparatus of claim 16, further comprising keyboard means
coupled to said processor means for transcribing said digital voice
data so as to provide transcribed digital voice data which is
stored in said memory means.
18. The apparatus of claim 17, wherein said processing means causes
a voice annotation marker indicating that said digital voice data
have been transcribed to be displayed on said display means at a
location corresponding to said portion of said patient data to
which said digital voice data are linked.
19. The apparatus of claim 18, wherein said processing means causes
said transcribed digital voice data to be displayed on said display
means when said voice annotation marker is selected using said
input means.
20. A method of operating an implantable device programmer
comprising the steps of:
displaying on display means a graphical representation of at least
a part of a patient data set;
receiving audio signals via transducer means;
converting said audio signals into electrical signals using said
transducer means;
converting said electrical signals into digital voice data using
analog to digital converter means;
storing said digital voice data in memory means; and
linking said digital voice data to a portion of said patient data
set.
21. The method of claim 20, wherein the step of linking said
digital voice data to a portion of said patient data set comprises
designating said portion of said patient data set using input
means.
22. The method of claim 21, further comprising the step of
displaying a voice annotation marker on said display means at a
location corresponding to said portion of said patient data
set.
23. The method of claim 22, further comprising the step of playing
back said digital voice data using speaker means.
24. The method of claim 23, further comprising the step of
displaying a playback indicator on said display means, and wherein
the step of playing back said digital voice data using said speaker
means comprises playing back said digital voice data using said
speaker means when said playback indicator is selected using said
input means.
25. The method of claim 21, wherein said input means comprises a
digitizer pen and wherein said display means comprises a digitizer
display screen, the method further comprising the steps of:
transcribing said digital voice data by writing on said digitizer
display screen with said digitizer pen so as to provide transcribed
digital voice data; and
storing said transcribed digital voice data in said memory
means.
26. The method of claim 21, further comprising the steps of:
transcribing said digital voice data using keyboard means so as to
provide transcribed digital voice data; and
storing said transcribed digital voice data in said memory
means.
27. The method of claim 26, further comprising the step of
displaying a voice annotation marker which indicates that said
digital voice data have been transcribed on said display means at a
location corresponding to said portion of said patient data
set.
28. The method of claim 27, further comprising the step of
displaying said transcribed digital voice data on said display
means when said voice annotation marker is selected using said
input means.
29. A method of operating an analyzer-programmer for use with an
implantable cardiac stimulating device implanted within a patient,
the method comprising the steps of:
receiving information relating to the patient's condition via
telemetry means;
displaying on display means a graphical representation of at least
a portion of a patient data set comprising said information
relating to the patient's condition;
designating a connection point of said patient data set using input
means;
receiving audio signals via transducer means;
converting said audio signals into electrical signals using said
transducer means;
converting said electrical signals into digital voice data using
analog to digital converter means;
storing said digital voice data in memory means; and
linking said digital voice data to said connection point.
30. The method of claim 29, wherein the step of receiving
information relating to the patient's condition comprises receiving
at least one of an atrial IEGM, a ventricular IEGM and marker data,
and said displaying step comprises displaying on said display means
at least one of said atrial IEGM, said ventricular IEGM and said
marker data.
31. The method of claim 30, further comprising the step of
displaying a voice annotation marker indicating that said digital
voice data have been transcribed on said display means at a
location corresponding to said connection point.
32. The method of claim 31, further comprising the steps of:
displaying a playback indicator on said display means; and
playing back said digital voice data using speaker means when said
playback indicator is selected using said input means.
Description
BACKGROUND OF THE INVENTION
This invention relates to implantable medical devices and
particularly to implantable cardiac stimulating devices, including
implantable cardiac pacemakers and implantable cardiac
defibrillators, as well as implantable cardioverters and
cardioverter/defibrillators. More particularly, this invention
relates to an analyzer-programmer computer for monitoring and
altering the performance of such implantable medical devices, which
allows a user to record voice annotations.
Implantable medical devices are used to treat a variety of
conditions. Implantable cardiac stimulating devices, such as
pacemakers and cardioverter-defibrillators, are examples of
implantable medical devices which are used to provide therapy for
various pathological cardiac arrhythmias.
Most modern implantable cardiac stimulating devices sense
electrical signals produced by the heart and then apply electrical
stimulation to the heart based on the detected signals. With every
beat of the patient's heart, the implantable cardiac stimulating
device makes decisions as to whether electrical stimulation is
necessary and what type of electrical stimulation to apply. These
decisions involve the analysis of medical data gathered in
real-time and the comparison of the gathered medical data against
standards by a computer program executed by a processor within the
implantable cardiac stimulating device.
The computer program carries out orders given by the patient's
physician. These orders are tailored by the physician for a
particular patient based upon the physician's training and
experience. Thus, the computer program is not an unalterable set of
instructions burned into the implantable cardiac stimulating device
at the time of manufacture. Note the term physician is used in this
application to include veterinarian and the term patient includes
both humans and animal patients.
Typically, a specialized computer called an analyzer-programmer is
used to communicate telemetrically with the implantable cardiac
stimulating device. The analyzer-programmer allows the physician to
analyze the patient's situation and reset the programming
parameters of the implantable cardiac stimulating device, or allows
another medical specialist to do so at the request of the
physician. The physician may use the analyzer-programmer to
customize the programming parameters as part of the procedure to
implant the implantable cardiac stimulating device. After the
device is implanted, the physician typically monitors the
performance of the patient's heart, the implantable cardiac
device's recognition and characterization of the patient's sinus
rhythm, the implantable cardiac stimulating device's choice and
timing of therapeutic electrical stimulation, and the reaction of
the patient's heart to the therapy.
To accomplish such programming and monitoring, the implantable
cardiac stimulating device is capable of receiving and transmitting
information from its implanted location to a telemetry head placed
on or near the surface of the patient's body. The process of
evaluating the performance of the implanted cardiac stimulating
device typically involves the analysis of atrial intercardiac
electrograms (AIEGMs) and ventricular intercardiac electrograms
(VIEGMs) telemetered out to the analyzer-programmer from the
implantable cardiac stimulating device. The AIEGM and VIEGM are
sources of information for use by the implantable cardiac
stimulating device in monitoring the heart. The implantable cardiac
stimulating device may also transmit marker data to the
analyzer-programmer. The marker data allow the physician to
identify occurrences of sensed or paced cardiac events.
A physician or medical specialist typically records an evaluation
of the patient's condition or diagnosis, and may also record
instructions for medical personnel as to the disposition of the
patient's records. For example, a physician may record the progress
made by the patient since the last visit, the success of a
particular therapy, and the patient's status report distribution
list (i.e., additional persons who should receive information about
the patient's current status).
This type of information is usually recorded by the physician using
a conventional audio tape recorder, or by making written notes.
However, using an audio tape (or written notes) to record and store
patient information has certain disadvantages. For example, the
tape (or written notes) may be misplaced or mixed up with other
tapes (or written notes). Typically, the tape (or written notes)
are given along with the patient's other data to appropriate
medical personnel who listen to and act on the recorded
instructions. The tape (or written notes) may be misplaced or mixed
up with other tapes (or written notes) during this process. In
addition, since multiple messages are often recorded on a single
audio tape, finding a particular piece of information on the tape
can be tedious and time consuming because one must locate the
position on the tape where the desired information resides.
U.S. patent application Ser. No. 08/510,367, filed Aug. 2, 1995, of
Snell and Levin, entitled "Improved User Interface for an
Implantable Medical Device Using an Integrated Digitizer Display
Screen" ("the '367 application"), which is hereby incorporated by
reference, describes a user interface which, among numerous other
functions, permits a user to annotate data with digitized,
handwritten notes. This system greatly reduces the possibility of
the information being lost or mixed up with other records because
the digitized annotations are stored in a computer memory device
along with the associated patient data. However, inputting the
information using a digitizer pen can be more time consuming than
using a tape recorder. In particular, it may be impractical to
input a large amount of information, such as a relatively lengthy
summary of a patient's condition, using a digitizer pen.
In view of the foregoing, it would be desirable to provide an
easy-to-use, convenient, and secure manner for a physician to
record an evaluation of a patient.
In particular, it would be desirable to allow a physician to record
spoken statements and then store those recorded statements as
digital data within the analyzer-programmer. Such a system would
allow the physician to securely record patient information,
including lengthy summaries of the patient's condition.
A system for controlling an implantable device programmer using
voice commands is described in U.S. patent application Ser. No.
08/664,070, filed Jun. 13, 1996 of Snell, entitled "Methods and
Apparatus for Controlling an Implantable Device Programmer Using
Voice Commands" ("the '070 application"). This system recognizes
voice commands given by a user and uses the commands to control an
implantable device via a telemetry circuit. However, the '070
application does not allow a user to record digital voice data
associated with patient data displayed on the display screen of the
implantable device programmer.
SUMMARY OF THE INVENTION
The present invention provides methods and apparatus for allowing a
user to record voice annotations. In a preferred embodiment, an
implantable device programmer is provided which includes a
processing circuit, a memory device coupled to the processing
circuit for storing digital data, a display screen coupled to the
processing circuit for displaying a graphical representation of at
least a portion of a patient data set, a transducer for converting
audio signals into electrical signals, and an analog to digital
converter coupled to the processing circuit and the transducer for
converting the electrical signals into digital voice data. The
digital voice data are stored in the memory device and are linked
to a portion of the patient data set.
The implantable device programmer preferably has an input device
coupled to the processor circuit for designating the portion of the
patient data set to which the digital voice data are to be linked.
A digitizer pen, for example, can be used as the input device. The
input device preferably is used by a user (such as a physician or
medical specialist) to designate the portion of the patient data
set to which the digital voice data are to be linked.
In a particularly preferred embodiment, the user links the digital
voice data to the patient data set by designating a connection
point using the input device. A voice annotation marker preferably
is displayed on the display screen at a location corresponding to
the connection point.
The implantable device programmer preferably has at least one
speaker coupled to the processor circuit for playing back the
digital voice data. The digital voice data preferably are played
back via the speaker when a playback indicator displayed on the
display screen is selected using the input device.
The implantable device programmer preferably has a conventional
keyboard coupled to the processor circuit for transcribing the
digital voice data. The transcribed digital voice data preferably
are linked to the portion of the patient data set to which the
digital voice data are linked. A voice annotation marker which
indicates that the voice annotation has been transcribed preferably
is displayed on the display screen at a location corresponding to
the portion of the patient data to which the digital voice data are
linked. The transcribed digital voice data preferably are displayed
on the display screen when the voice annotation marker is selected
using the input device.
In an alternative embodiment, a digitizer pen is used to transcribe
the digital voice data by writing on a digitizer display screen so
as to provide transcribed digital voice data which are stored in
the memory device.
The present invention also provides methods for operating an
implantable device programmer. In a preferred embodiment, the
method is used with an implantable device programmer having a
processing circuit, a memory device coupled to the processing
circuit, a display screen coupled to the processing circuit, a
transducer, and an analog to digital converter coupled to the
processing circuit and the transducer. In accordance with a
preferred embodiment of a method of the present invention, a
graphical representation of at least a part of a patient data set
is displayed on the display screen. Audio signals are received and
converted into electrical signals by the transducer. The electrical
signals are then converted into digital voice data by the analog to
digital converter. The digital voice data are stored in the memory
device, and are linked to a portion of the patient data set.
The implantable device programmer preferably has an input device
coupled to the processor circuit, and the step of linking the
digital voice data to a portion of the patient data set preferably
comprises designating the portion of the patient data set to which
the digital voice data are to be linked using the input device.
A voice annotation marker preferably is displayed on the display
screen at a location corresponding to the portion of the patient
data set to which the digital voice data are linked.
The implantable device programmer preferably has at least one
speaker, and the method preferably includes the step of playing
back the digital voice data using the speaker. The digital voice
data preferably are played back when a playback indicator displayed
on the display screen is selected using the input device.
The implantable device programmer preferably has a conventional
keyboard coupled to the processing circuit, and the method
preferably includes the steps of transcribing the digital voice
data using the keyboard so as to provide transcribed digital voice
data, and storing the transcribed digital voice data in the memory
device. A voice annotation marker preferably is displayed on the
display screen at a location corresponding to the portion of the
patient to which the digital voice data are linked.
The transcribed digital voice data preferably are displayed on the
display screen when the voice annotation marker is selected using
the input device.
In a alternative embodiment, the input device is a digitizer pen
and the display screen is a digitizer display screen, and the
method includes the steps of transcribing the digital voice data by
writing on the digitizer display screen with the digitizer pen so
as to provide transcribed digital voice data, and storing the
transcribed digital voice data in the memory device.
The apparatus and methods for recording voice annotations provided
by the present invention can be used to record any type of
information, including, but not limited to, an evaluation of the
patient's condition or diagnosis, and instructions for medical
personal as to the disposition of the patient's records. Recording
a voice annotation in accordance with the present invention allows
the physician to easily, conveniently, and securely record such
information.
BRIEF DESCRIPTION OF THE DRAWINGS
The above and other objects and advantages of the invention will be
apparent upon consideration of the following detailed description,
taken in conjunction with the accompanying drawings, in which like
reference characters refer to like parts throughout, and in
which:
FIG. 1 is a perspective view of a preferred tablet computer for use
with the present invention;
FIG. 2 is a block diagram of the tablet computer of FIG. 1 showing
functional elements;
FIG. 3 is a block diagram of the tablet computer of FIGS. 1 and 2,
showing the tablet computer connected to a base station, the base
station being further connected to a patient records computer and
to peripheral devices;
FIG. 4 is a sample screen display on the digitizer display screen
of the tablet computer;
FIG. 5 is a sample screen display on the digitizer display screen
with real-time data in the upper window and frozen data in the
lower window;
FIG. 6 is a portion of a screen display on the digitizer display
screen showing the designation of a connection point during the
recording of a voice annotation in accordance with the present
invention;
FIG. 7 is a portion of a screen display on a digitizer display
screen during the confirm cycle of the designation of a connection
point;
FIG. 8 is a portion of a screen display on the digitizer display
screen showing a control window for use when recording a voice
annotation;
FIG. 9 is a portion of a screen display on the digitizer display
screen after a voice annotation has been created;
FIG. 10 is a portion of a screen display on the digitizer display
screen after the voice annotation of FIG. 9 has been selected for
display;
FIG. 11 is a portion of a screen display on the digitizer display
screen illustrating the deletion of a voice annotation using an
eraser tool;
FIG. 12 is a portion of a screen display on the digitizer display
screen depicting the display after a voice annotation has been
deleted using the eraser tool;
FIG. 13 is a portion of a screen display on the digitizer display
screen illustrating movement of a voice annotation;
FIGS. 14 is a portion of a screen display on the digitizer display
screen depicting the display after a voice annotation has been
moved;
FIG. 15 is an illustrative screen display used to manage previously
saved sets of screen displays and medical data;
FIG. 16 is an illustrative screen display for review of a set of
saved data, the screen display including a transcribe button;
FIG. 17 is a preferred screen display used to select a voice
annotation for transcription;
FIG. 18 is a preferred screen display after a voice annotation has
been transcribed;
FIG. 19 is a preferred screen display in the review mode after a
voice annotation has been transcribed;
FIG. 20 is preferred screen display in the review mode after the
voice annotation marker of FIG. 22 has been selected;
FIG. 21 is an alternative screen display showing a voice annotation
that has been transcribed using a digitizer pen;
FIG. 22 is an alternative screen display in the review mode showing
a voice annotation that has been transcribed using a digitizer pen;
and
FIG. 23 is a sequence of steps for carrying out a preferred
embodiment of the present invention.
DETAIL DESCRIPTION OF THE PREFERRED EMBODIMENTS
For purposes of illustration, the present invention is described
hereinbelow in the context of the portable, pen-based
analyzer-programmer described in the above-incorporated '367
application. Those skilled in the art will appreciate, however,
that the present invention is not limited to use with a pen based
analyzer-programmer, but has much broader applications. In
alternative embodiments, the present invention can be implemented
in conventional, non-portable analyzer-programers having
conventional keyboard input devices, as well as
analyzer-programmers having touch screen input devices.
Referring to FIG. 1, a tablet computer 100, and a pen 102 for
inputting information are shown along with components of the tablet
computer. The pen 102 can be used to write, draw, or select among
presented choices. The pen 102 is effective on a digitizer display
screen 104. The digitizer display screen 104 comprises the majority
of the front face of the tablet computer 100. The digitizer display
screen 104 is comprised of a display 106 and a digitizer 108 which
overlap one another. The digitizer 108 preferably is underneath the
display 106. The term "underneath" and the phrase "on the surface
over" shall be used to describe the corresponding positions of the
digitizer 108 and the display 106, respectively. The terms "above"
and "below" will be used to describe position in the plane of the
display 106 or the digitizer 108.
The pen 102 preferably is one of the commercially available pens
that alter a radio frequency signal transmitted by the digitizer
108. This altered signal is sensed by the digitizer 108 when the
pen 102 is within the sensing range of the digitizer 108. The
sensing range is approximately one-quarter inch. Contact of a pen
tip 110 with any surface causes a very slight movement of the pen
tip 110 back into the body of the pen 102. This depression of the
pen tip 110 triggers a switch (not shown) within the pen 102 and
changes the way the pen 102 alters the transmitted signal.
Typically, the depressed tip signal is used for input and the other
pen signal is used as a feedback signal to help the physician or
medical specialist place the pen 102. The tablet computer 100
responds to the pen input by causing an image to be displayed on
the display 106.
Emergency keys 112 preferably are provided on the tablet computer
100. The emergency keys 112 provide the physician or medical
specialist with several important functions for controlling the
tablet computer 100 during an emergency. One of the emergency keys
112 may request that the tablet computer 100 send a particular
command to the implantable medical device (described below in
connection with FIG. 2), or may request action by the tablet
computer 100 itself such as a reset of the tablet computer 100 or a
request of the tablet computer 100 to display a screen display with
information and options that are useful when managing an emergency.
The emergency keys 112 allow the physician or medical specialist to
intervene quickly even if the pen 102 is misplaced. The emergency
keys 112 allow action without the delay inherent in entering the
sequence of commands that would otherwise be required to request
the tablet computer 100 to display the screen display with the
emergency functions.
The tablet computer 100 is powered by a battery (described below in
connection with FIG. 2). The tablet computer 100 is turned on and
off with an on/off switch 114.
Referring now to FIG. 2, an implantable medical device 116 can
sense cardiac activity and provide therapeutic electric stimulation
through electrical leads (not shown). The information received by
the implantable medical device 116 include IEGM waveforms from the
atrial and ventricular regions of the heart, and marker data
channel information generated within the implantable medical device
116. Marker data channel information contains a record of discrete
acts of the implantable medical device 116 such as the application
of a therapeutic electric pulse, and also the recognition by the
implantable medical device 116 of certain heart activities as
sensed by the implantable medical device 116.
The AIEGM measurement information, VIEGM measurement information,
marker data channel information, and the time of each measurement
and each marker data channel marker can be stored in a limited
amount of memory (not shown) within the implantable medical device
116. The current (real-time) or stored medical data in the
implantable medical device can be transmitted through the tissue
and skin of the patient to a telemetry head 118.
The term "real-time" does not necessarily mean instantaneous. The
term is in contrast with "batch processed" information. "Real-time"
refers to a system that controls an ongoing process and delivers
the output not later than the time that it is needed for effective
control. Thus, the cardiac data is real-time data (or current data)
even if the various processing steps introduce a delay between a
cardiac event and the display of the cardiac information.
The telemetry head 118 is attached to a telemetry electronics
module 120 by a telemetry cable 122 which is preferably
approximately six feet long. The telemetry electronics module 120
is plugged into a telemetry port 124. (Note that the connection of
the telemetry cable 122 into the telemetry electronics module 120
and the telemetry port 124 is also shown in FIG. 1.) The telemetry
electronics module 120 performs conversions of the telemetry data
such as a conversion from analog data to digital data if the
implantable medical device 116 does not itself perform the
analog-to-digital conversion. The preferred embodiment uses the
same cable and port for telemetry data transmitted in either
direction between the tablet computer 100 and the implantable
medical device 116. A system (not shown) with an output port on the
tablet computer 100 and a cable dedicated to output along one
communication path to the telemetry head 118 and having a separate
input port on the tablet computer 100 with a separate cable
dedicated to input from a separate communication path to the
telemetry head 118 could also use the teachings of this
invention.
Another channel of medical data can be collected from surface ECG
leads 126. The surface ECG leads 126 are placed on the skin of the
patient (not shown). A surface ECG cable 128 has a number of
strands that preferably can be attached and detached to the surface
ECG leads 126. The surface ECG leads 126 are connected via the
surface ECG cable 128 to a patient interface module 130 which
performs conversion of the surface ECG waveform into digital format
and performs other processing of the waveform data. The patient
interface module 130 is connected to the tablet computer 100 by a
medical data port cable 132 at a medical data port 134. (Note that
the connection of the medical data port cable 132 to the medical
data port 134 is also shown in FIG. 1.)
The tablet computer 100 is provided with energy during mobile
operation by a battery 136 connected to a power supply circuit 138.
The digitizer display screen 104 is shown in FIG. 2 in its
constituent parts: the digitizer 108 and the display 106. The input
from the pen 102 is received by the digitizer 108 and placed in an
acetate layer memory 140 where the input is processed in processing
and memory circuit 142.
The term acetate layer memory is used to describe a section of
memory that stores information that is displayed as an overlay over
some other information. Acetate layer memory is so called because
the overlay information seems to be stored on a transparent layer
of acetate and that can be selectively overlaid over the other
information. Thus, the term is descriptive of the function of the
memory rather than the type of memory. The processing and memory
circuit 142 interprets the input, and then deletes the input from
the acetate layer memory 140 and moves a copy of certain input into
a display logic and memory circuit 144. The display logic and
memory circuit 144 controls the display 106.
In accordance with the present invention, a speaker 146 preferably
is used to play back digital voice data recorded by the tablet
computer 100. The speaker 146 preferably is also used to provide
audio alarms in response to detected problems concerning the
patient's heart, the monitoring equipment, the input from the
physician or medical specialist, or other problems. The speaker 146
can also be used to confirm receipt of input.
The tablet computer 100 contains a print queue memory 147 which
stores requests to create printouts until the tablet computer 100
is connected directly or indirectly to a printer (described below
in connection with FIG. 3). The print queue memory 147 is
non-volatile memory and preferably is a memory card.
In addition to the acetate layer memory 140, the memory in the
processing and memory circuit 142, the memory in the display logic
and memory circuit 144, and the non-volatile memory in the print
queue memory 147, the tablet computer 100 has a general memory unit
148. The general memory unit 148 preferably is used to store
patient data and reference material available to the physician or
medical specialist such as a dictionary, phone directory, medical
reference text, or reference manuals on implantable medical
controllers
A conventional hard drive preferably is used for the general memory
unit 148. Alternative choices for the general memory unit include a
non-volatile memory card or a read and write optical memory.
Another alternative (not shown) is to use a read only memory device
to store the reference material. This read only memory would be on
a cartridge, optical disk or other easily replaced device so that
periodic updates could be made to the reference material.
In addition to the emergency keys 112, a reset key 149 is
preferably provided to re-initialize the tablet computer 100.
Alternatively, the reset key could be one of the emergency keys
112.
In accordance with the present invention, a transducer 150 is
provided in order to receive voice data from the physician. The
transducer 150 preferably is mounted under perforations 151 (FIG.
1) in the tablet computer 100. (In an alternative embodiment (not
shown), a separate transducer which plugs into a tablet computer is
provided.) The transducer 150 preferably converts audio signals to
analog electrical signals. An analog to digital (A/D) converter 152
preferably converts the analog electrical signals into digital
data. The digital data from the A/D converter 152 preferably are
preprocessed by a digital signal processor (DSP) 153 before passing
to the processing and memory circuit 142. (In an alternative
embodiment (not shown) the DSP is omitted and the digital data from
the A/D converter preferably pass directly to the processing and
memory circuit.)
Referring now to FIG. 3, the tablet computer 100 is periodically
inserted into a base station 154. A tablet computer power pickup
156 mates with a base station power jack 158 during the insertion
of the tablet computer 100 into the base station 154 to provide a
source of power to the tablet computer 100 which is sufficient to
both operate the tablet computer 100 and to charge the battery 136
in the tablet computer 100. A battery charger 160 is contained in
the base station 154 for charging batteries 136 for use in the
tablet computer 100. The base station 154 is equipped with
conventional power supply circuitry (not shown) connected to line
voltage by a line voltage plug (not shown).
The base station 154 and tablet computer 100 have connections that
allow the tablet computer 100 to communicate with the base station
154 when inserted in the base station 154. LEDs (light emitting
diodes) preferably are used for an infrared serial communication
link between the tablet computer 100 and the base station 154.
Specifically, a base station output port 162 preferably is placed
adjacent to a tablet input from base port 164 and a base station
input port 166 preferably is placed adjacent to a tablet output to
base port 168. These ports preferably are small windows for
transmitting the infrared signals. As shown in FIG. 3, small gaps
exists between the communication ports (162 to 164 and 166 to 168)
as distinguished from the physical contact established between the
base station power jack 158 and the tablet computer power pickup
156.
Although conventional physical cable connections could be used, the
infrared serial connection is preferred over conventional physical
cable connections for two reasons. The first reason is that the
infrared connections are not subject to physical wear and tear from
the repeated insertion and removal of the tablet computer 100 into
the base station 154.
The second reason to use infrared connections instead of
conventional physical connections is electrical isolation of the
tablet computer 100 from other equipment. Electrical isolation is
important in the design of medical equipment because of concerns
for patient safety.
An internal printer 170 preferably is integral to the base station
154. The internal printer 170 is preferably a thermal printer. A
laser printer 172 preferably is connected to the base station 154
by a laser printer connection cable 174. Other printers (not shown)
such as ink jet printers or dot matrix printers with resolutions
sufficient to reproduce the medical data may also be used. A
display screen 175 preferably is connected to the base station
154.
The base station 154 is at least periodically connected by a base
to host cable 176 to a patients' records computer 178. The
patients' records computer 178 is connected to a patients' records
computer display 180, a patients' records computer keyboard 182,
and a memory device 184. The memory device 184 stores medical data
records and other information that is relevant to the use of the
tablet computer 100.
The base station 154 preferably has a keyboard port 186 for
connecting a keyboard 188. The keyboard 188 preferably can be used
by field service engineers in customizing the tablet computer 100,
and preferably can be used to transcribe voice annotations (as
described below in connection with FIGS. 17-18). An optional
attachment is a bar code reader (not shown) which could be
connected to the keyboard port 186 to allow bar codes to be
scanned. As an example of bar code reader use, some hospitals may
position the base station 154 along with the bar code reader into
the operating room to read a patient identification bar code number
along with the bar code representation of each piece of equipment
or material used during the implantation of the implantable medical
device 116 (FIG. 2).
Analog output ports 190 and 192 are provided so that other devices
can be connected to the base station 154. The medical data provided
to the tablet computer 100 through the medical data port 134 (FIG.
2) and the telemetry port 124 (FIG. 2) can be passed through the
tablet output to base port 168 to the base station input port 166
and converted into analog form in a digital-to-analog converter 194
before passing out of one of the analog output ports 190 or 192 to
peripheral devices such as paper chart recorders (not shown), large
video monitors (not shown) for use in teaching, or calibration
equipment (not shown).
A view of the digitizer display screen 104 is shown in FIG. 4. The
screen display has an upper window 198 and a lower window 200. The
screen display contains vertical tabs 202 and horizontal tabs 204.
The physician or medical specialist uses the vertical and
horizontal tabs 202 and 204 to move from one screen display to
another screen display. Tapping one of the vertical tabs 202
triggers the button on the digitizer display screen 104 underneath
the displayed image of the tab. This tapping will cause the tablet
computer 100 (FIG. 1) to jump to the first screen display in a
series of related screen displays. Vertical tabs 202 are preferably
made to resemble tabs on a three-ring binder in order to facilitate
intuitive use.
Individual windows may have horizontal tabs 204. In FIG. 4, the
lower window 200 has horizontal tabs 204 to change the lower window
200 without affecting the rest of the screen display. A highlighted
vertical tab 206 and a highlighted horizontal tab 208 remind the
physician or medical specialist of the context of the current
screen display. In this case, the highlighted vertical tab 206
displays the tab labeled "ECG Machine" and the highlighted
horizontal tab 208 displays the tab labeled "Parameters."
In this screen display, a series of buttons 210 are above the upper
window 198 on the digitizer display screen 104. The series of
buttons 210 contain choices such as print or save that are used in
a large number of screen displays. The button choices are updated
by the tablet computer 100 (FIG. 1) to reflect currently valid
choices. A series of programming parameters 212 is displayed in the
lower window 200. A rectangle 214 preferably is displayed as a
visual aid for the physician or medical specialist. The rectangle
214 appears when the pen 102 (FIG. 1) is within sensing range of
the digitizer display screen 104. The rectangle 214 moves from one
program parameter to the next as the pen 102 (FIG. 1) moves. In
this case, the rectangle 214 moves up and down the screen display
as the pen 102 (FIG. 1) moves up and down the surface of the
digitizer display screen 104. The use of the rectangle 214 or other
method of highlighting (not shown) allows the physician or medical
specialist to accurately select a particular object from among many
densely packed objects.
When the telemetry head 118 (FIG. 2) is sufficiently close to the
implantable medical device 116 (FIG. 2) to establish a telemetry
link, medical data sensed by the implantable medical device 116
(FIG. 2) can be passed via the telemetry link as described above.
Current measurements of medical data preferably are displayed in
the upper window 198 of most screen displays.
Normally, four channels of information will be simultaneously
displayed. The four channels are a surface ECG channel 226, a
marker data channel 228, an atrial IEGM (AIEGM) channel 230, and a
ventricular IEGM (VIEGM) channel 232. The current medical data is
motionless until updated by a left to right sweep of a sweep bar
234.
In addition to the display of current medical measurements, the
tablet computer 100 (FIG. 1) can be used to examine stored medical
measurements. In FIG. 5, the upper window 198 is displaying current
medical data and is being updated by the sweep bar 234. Tapping a
frozen ECG button 296 causes a portion of the patient data scroll
to be displayed in the lower window 200. The patient data scroll
preferably includes the data received by the tablet computer 100
from the surface ECG channel 226, the marker data channel 228, the
frozen AIEGM channel 230, and the frozen VIEGM channel 232. Tapping
a freeze button 298 copies the most recent two minutes of the
patent data into the lower window 200.
Frozen ECG machine controls buttons 300 are on the right side of
the lower window 200. An indication of time 302 is provided to the
left of the horizontal tabs 204, which displays the time of
measurement of the portion of the patient data scroll displayed at
the left edge of the lower window 200. An indication of date 304 is
provided to the right of the horizontal tabs 204 if the patient
data scroll was recorded on a date other than the current date.
Below the lower window 200 is a compressed buffer overview 306 and
an indication of position 308. The compressed buffer overview 306
shows a view of the patient data scroll which has been shrunk to
fit into the window allocated to the compressed buffer overview
306. The rendition reflects the relative positions and gains of a
frozen surface ECG channel 310, a frozen AIEGM channel 312, and a
frozen VIEGM channel 314 (all shown in lower window 200). A frozen
marker data channel 316 (shown in lower window 200) is not
reproduced in the compressed buffer overview 306.
An indication of position 308 is provided to indicate the currently
displayed portion of the patient data scroll. A flag 318 is added
to the compressed buffer overview 306 whenever an annotation 320 is
created in order to aid in locating the relevant portion of the
patient data scroll. The flag 318 is comprised of a flagstick 322
and a pennant 324. The base of the flagstick 322 points to the
position in the compressed buffer overview 306 representative of
the location of the annotation 320. The pennant 324 contains a
unique symbol 326 to identify the annotation 320. In the preferred
embodiment a letter of the alphabet is used, starting with "A" for
the first annotation and "B" for the second. The unique symbol 326
preferably does not contain information indicative of the type of
annotation. The unique symbols 326 preferably are not reordered or
reissued if an annotation is deleted.
A flag jump right button 328 is provided to the right of the
compressed buffer overview 306 and a flag jump left button 330 is
provided to the left of the compressed buffer overview 306. Tapping
the flag jump right button 328 causes the undisplayed flag located
nearest to the right side of the currently displayed portion of
data to be displayed in the lower window 200. Tapping the flag jump
left button 330 causes the undisplayed flag located nearest to the
left side of the currently displayed portion of data to be
displayed. A "page forward" button 332 and a "page back" button 334
are provided on either side of a pen tool icon bar 336. The page
forward button 332 advances the patient data scroll one visible
segment 270. Conversely, the page back button 334 moves the patient
data scroll one visible segment 270 to the left.
An alternative method of changing the displayed portion of the
compressed buffer overview 306 is to tap the pen 102 (FIG. 1) on
the flag pennant 324. This moves the patient data scroll so that
the selected flag's annotation and the associated segment of
patient data scroll is displayed in the lower window 200.
Another tool for making small horizontal adjustments to the patient
data scroll is provided on the pen tool icon bar 336. Tapping a
hand tool icon 338 on the pen tool icon bar 336 turns the pen 102
(FIG. 1) into the hand tool. When the pen 102 (FIG. 1) is
functioning as the hand tool, placing the pen 102 (FIG. 1) anywhere
on the lower window 200 and then dragging the pen 102 (FIG. 1)
horizontally causes the patient data scroll to move in the
horizontal direction with the pen 102 (FIG. 1) as if the pen 102
(FIG. 1) was holding onto the patient data scroll. The pen 102
(FIG. 1) continues to function as the hand tool until the hand tool
icon 338 is tapped again on the pen tool icon bar 336.
The tablet computer 100 preferably permits the physician to create
both ink annotations and footnote annotations on the patient data
scroll as described in the aforementioned '367 application.
Briefly, an ink annotation allows the physician to "write" directly
on the displayed data using the digitizer pen, while a footnote
annotation allows the physician to enter text into a footnote
window associated with a footnote marker.
Turning to FIG. 6, the manner by which the physician or medical
specialist can create voice annotations in accordance with the
present invention is described. Before creating a voice annotation,
the physician has annotated the frozen AIEGM channel 312 with a
circular ink annotation 348 around one AIEGM waveform using the ink
tool as described in the '367 application. A flag 349 with a unique
identifier "C" was added to the compressed buffer overview 306 to
mark the location of the circular annotation 348.
Voice annotation of the medical data preferably is initiated by
tapping the pen 102 (FIG. 1) onto a voice annotation tool icon 350.
After tapping the voice annotation tool icon 350, a dark square 352
highlights the voice annotation tool icon 350 indicating that the
tablet computer is in the voice annotation mode. The physician
preferably designates a "connection point" when creating a voice
annotation in order to link the voice annotation to a particular
portion of the patient data. The connection point allows the
annotation to follow the appropriate segment of medical data when
the channel of medical data is moved.
After tapping the voice annotation tool icon 350, the tablet
computer 100 reminds the physician with a pop-up message 354 to
designate a connection point. The tablet computer 100 expects that
the next input from the pen 102 (FIG. 1) will designate the
connection point. Preferably, the physician designates the
connection point by tapping a location in the lower display window
200.
As shown in FIG. 7, the point at which the physician tapped the
lower display window 200 preferably is indicated with a set of
cross hairs 356. A confirmation window 358 is preferably provided
in order to confirm the designation of the connection point.
Tapping a confirmation-no button 360 with the pen 102 (FIG. 1)
requests another opportunity to designate a connection point. The
selection of a connection point is completed by tapping a
confirmation-yes button 362.
In an alternative embodiment (not shown), the confirmation cycle
can be eliminated to streamline the designation of the connection
point.
Turning to FIG. 8, once the selection of a connection point is
complete, a voice annotation marker 364 preferably appears at the
connection point. In this case, the voice annotation marker 364 is
labeled with the letter "D." This preferably is the same letter as
is used to label a corresponding flag in the compressed buffer
overview 306 (described below in connection with FIG. 9) when
recording of the voice annotation is complete. The voice annotation
marker 364 preferably is shaped like a speaker in order to indicate
to the physician that the marker 364 relates to a voice annotation
rather than another type of annotation (e.g, an ink or footnote
annotation).
If the voice annotation pertains to one particular channel of
medical data and the physician or medical specialist wishes to
identify the channel being annotated, an ink annotation such as an
arrow or circle annotation 348 can be added to highlight the
subject of the voice annotation. FIG. 8 serves as an example of
this combination of ink and voice annotations for a particular
piece of medical information. Of course, a voice annotation can be
added to the patient data scroll without an accompanying ink
annotation.
After the physician has confirmed the connection point, a control
window 368 appears in the lower window 200 as shown in FIG. 8.
Tapping a begin recording button 370 preferably causes the tablet
computer 100 to begin recording voice data. The physician
preferably taps the stop recording button 372 to stop recording
voice data. If the physician wishes to add to the voice annotation
after tapping the stop recording button 372, the physician presses
the begin recording button 370 again to continue recording. In a
preferred embodiment, this process may be repeated any number of
times.
An example of recording a voice annotation is now given for
purposes of illustration. The physician first taps the begin
recording button 370 and then speaks the words, "one AIEGM pulse
had an unusually high voltage differential of about one-point-five
millivolts." The physician then taps the stop recording button 372.
Digital data corresponding to the sounds spoken by the physician
preferably are stored in the general memory unit 148 (FIG. 1) of
the tablet computer 100 (FIG. 1).
The present invention can be used to record voice annotations of
any length provided that the tablet computer has sufficient
available memory to store the corresponding digital data. A voice
annotation can include any type of spoken information, including,
but is not limited to, progress made by a patient since the last
visit, the success of a particular therapy, and the patient's
status report distribution list. The voice annotation could also
include non-spoken sounds such as computer generated sounds. (The
term "digital voice data" used herein to refer to the digital data
of a voice annotation is meant to include the digital data
corresponding to such non-spoken sounds.)
The physician taps a playback button 374 to cause the voice
annotation to be played back for review.
Tapping a clear button 376 deletes all previously entered voice
data for the current voice annotation, but leaves the control
window 368 on the display screen so that the physician can compose
a new message. A confirm cycle preferably is provided when the
clear button 376 is pressed in order to prevent the accidental
deletion of voice data.
Tapping a cancel button 378 closes the control window 368 and ends
the voice annotation input step without saving the voice
annotation. A confirm cycle preferably is provided when the cancel
button 378 is pressed in order to prevent the accidental deletion
of voice data.
Tapping a done button 380 preferably will end the input step, save
the voice data input, and add another flag (described below in
connection with FIG. 9) to the compressed buffer overview 306.
The playback button 374, the clear button 376, the cancel button
378, and the done button 380 preferably are inactive while the
physician is recording a voice annotation. That is, these buttons
preferably are inactive between the time when the physician taps
the begin recording button 370 and the time when the physician taps
the stop recording button 372. In an alternative embodiment (not
shown), the playback button 374, the clear button 376, the cancel
button 378, and the done button 380 are shaded while the physician
is recording a voice annotation in order to indicate that they are
inactive. In another alternative embodiment (not shown), the
playback button 374, the clear button 376, the cancel button 378,
and the done button 380 are hidden while the physician is recording
a voice annotation.
The result of tapping the done button 380 appears in FIG. 9, with a
flag 382 labeled "D" marking the new voice annotation. The flag 382
substantially covers the flag 349 labeled "C" (mostly covered and
not visible) marking the ink tool annotation. After the done button
380 has been tapped, the physician can move to other portions of
the patient data scroll using the flag jump right button 328, the
flag jump left button 330, the page forward button 332, the page
back button 334, and the hand tool 338 as described above. The
physician can also move to a particular flag by tapping on that
flag in the compressed buffer overview 306 as described above. The
physician can move to other portions of the patient data scroll and
then create additional voice annotations. The physician can also
move to and select a previously recorded voice annotation in order
to modify it.
FIG. 10 shows the display screen after the physician has selected
the voice annotation marker 364 corresponding to a previously
recorded voice annotation. The screen is similar to the screen of
FIG. 8 except that the flag 382 and a date and time of recording
384 appear on the display screen. The date and time of recording
384 preferably show the date and time at which the voice annotation
was recorded. The physician preferably can add further voice data
to the voice annotation using the control window 368. In
particular, tapping the begin recording button 370 permits the
physician to record voice data which preferably is added to the end
of the previous voice annotation, rather than replacing the
previous voice annotation. When the physician is finished recording
the additional voice data, he or she taps the stop recording button
372.
Tapping the playback button 374 preferably causes the voice
annotation to be played back, including any newly recorded voice
data.
Tapping the clear button 376 preferably deletes all voice data
entered for a particular voice annotation since that voice
annotation was selected. That is, tapping the clear button 376
preferably does not effect any voice data recorded before the voice
annotation marker 364 was selected for display. A confirm cycle
preferably is provided when the clear button 376 is pressed in
order to prevent the accidental deletion of voice data. As is the
case when recording a new voice annotation, the control window 368
preferably remains displayed after the clear button 376 is
pressed.
Tapping the cancel button 378 preferably ends the display of the
voice annotation without saving the voice data recorded while the
voice annotation marker 364 was selected. Previously recorded voice
data preferably is not effected by tapping the cancel button 378. A
confirm cycle preferably is provided when the cancel button 378 is
pressed in order to prevent the accidental deletion of voice
data.
Tapping the done button 380 preferably ends the display of the
voice data and preferably saves any additional voice data that was
recorded while the voice annotation marker 364 was selected. If any
new voice data has been recorded, then the date and time of
recording of the new voice data preferably is saved.
Although FIGS. 6-10 illustrate the creation of a single voice
annotation, the physician can create two or more voice annotations
which appear on the same screen display.
Referring to FIG. 11, a voice annotation can be deleted by touching
the voice annotation marker 364 with the pen tip 110 (FIG. 1) while
the pen 102 (FIG. 1) is an eraser tool. To make the pen 102 (FIG.
1) an eraser tool, the user taps an eraser tool icon 385. FIG. 11
shows the display screen after the user has tapped the eraser tool
icon 385 and then tapped the voice annotation marker 364. The
eraser tool icon 385 is highlighted by a box 386, and a
confirmation window 387 having a "YES" button 388 and a "NO" button
389 is displayed in the lower window 200 to prevent accidental
erasure of a voice annotation. If the user taps the "NO" button
389, the voice annotation is not deleted and the pen 102 (FIG. 1)
no longer acts an eraser tool. If the user taps the "YES" button
388 then the voice annotation marker 364 is deleted.
As shown in FIG. 12, deleting the voice annotation removes the
voice annotation marker 364 from the lower window 200. The flag 382
labeled "D" corresponding to the deleted voice annotation is
removed from the compressed buffer overview so that the flag 349
labeled "C" becomes visible. Save requests made after the deletion
of the voice annotation will not include the voice annotation.
Referring to FIG. 13, a voice annotation may be moved with a press
and hold gesture. Pressing the pen 102 (FIG. 1) upon the voice
annotation marker 364 in the lower window 200 for a predetermined
minimum amount of time (preferably about one-half second) is
recognized by the tablet computer 100 (FIG. 1) as the start of a
press and hold gesture. Upon recognition, the tablet computer 100
(FIG. 1) places a marquee such as a blinking double line box 390
around the selected voice annotation marker 364.
After the marquee appears, the marquee and the voice annotation
marker 364 it surrounds will "float". Floating means that the
selected item will follow the pen 102 (FIG. 1) until the physician
or medical specialist presses and holds the pen 102 (FIG. 1) for at
least one-half second to affix the selected item to a new location.
The marquee disappears when the item has been affixed. To move the
selected item to a new location, the physician or medical
specialist touches the selected item with the pen 102 (FIG. 1) and
drags to pen 102 (FIG. 1) to the new location. The selected item
continues to float until affixed, so the movement of the selected
item does not need to happen within a single drag movement of the
pen 102 (FIG. 1). Consequently, while an item is floating, the
physician or medical specialist may move the scroll using other
gestures such as the various flick gestures or other aids such as
the page forward button 332 or the page back button 334.
As illustrated in FIG. 13, the voice annotation marker 364 was
originally placed so that it covered part of a pulse 391 and part
of the ink annotation 348. Arrow 392 indicates that the user has
dragged the voice annotation marker 364 to the right so that it no
longer covers the pulse 391 and ink annotation 348. FIG. 14 shows
the voice annotation marker 364 after the user has released it. The
pulse 391 and the ink annotation 348 are now clearly visible.
In an alternative embodiment (not shown), the voice data recorded
by the tablet computer 100 are "compressed" before being stored in
order to reduce the amount of data that must be saved for a voice
annotation. Compressing the voice data, however, has the
disadvantage of increasing the amount of time necessary to record
or playback a voice annotation. Techniques for compressing digital
data are well known in the art.
Special software programs called voice recognition engines are
known and have been applied to personal computers. Such engines
allow voice input to be recognized as words and then manipulated as
digital data. In an alternative embodiment (not shown), the tablet
computer 100 is programmed using a voice recognition engine so that
the words spoken by the physician while recording a voice
annotation are recognized by the tablet computer 100 and converted
to digital data. In this embodiment, the words spoken by the
physician appear in text form in a window (not shown) on the
display screen of the tablet computer 100. The physician preferably
uses a conventional text editor to edit the text displayed in the
display window. A disadvantage of using voice recognition software
is that currently available voice recognition engines are able to
recognize only a relatively limited number of words. This
embodiment may be advantageous, however, in situations where only a
limited number of words are used by the physician.
A "save" function creates a copy of all information and annotations
for a particular patient. Referring back to FIG. 9, a save button
393 is one of the series of buttons 210 on the top of many screen
displays. The save function is useful when the physician or medical
specialist does not have time to examine and annotate frozen
medical data and wishes to do so later. For example, some medical
procedures cause discomfort. The physician or medical specialist
may wish to continue the exam rather than continue annotating the
results while the patient is uncomfortable. In some situations, the
patient's situation may change too quickly to fully annotate the
results such as when the tablet computer 100 (FIG. 1) is used in an
emergency room or operating theater. A third possibility is that
the physician or medical specialist may want to capture the
complete set of data for discussion with peers or students. A
fourth possibility is that the physician may wish to save the data
set, including all voice annotations, so that a medical specialist
or other appropriate personnel can transcribe the voice annotations
and carry out any instructions recorded on the voice
annotations.
The physician or medical specialist preferably is not allowed to
select which screen displays, patient data scrolls, or other
material is saved. All information that is relevant to the patient
preferably is saved. The physician or medical specialist who
requests another save after making just one minor change to one
screen display preferably saves an entire set of data, display
screens, and related material. Although this may seem inefficient,
the advantages of speed, simplicity of commands, and assurance of
capturing all necessary information outweigh the disadvantage of
storing some unwanted or redundant information.
Turning now to FIG. 15, the save catalog menu lists the sets of
saved data. The sets of saved data are identified by a saved set
name 394 comprising a model number and a serial number of the
implantable medical device coupled with a date and a time when the
data was saved. If known to the tablet computer 100 (FIG. 1), a
name of the patient is provided as an aid to physician or medical
specialist in finding a particular patient's data.
Tapping a review button 395 and then tapping on the saved set name
394 of the desired set of saved data will return the physician or
medical specialist to the screen display that was open when the
save request was made. Tapping a delete button 396 and then tapping
on a save catalog line number 397 causes the letters 'DEL" appear
in place of the selected save catalog line number 397. Tapping the
letters "DEL" will cause the letters "DEL" to disappear, and the
selected save catalog line number 397 to reappear. In this case the
save catalog line number 397 that can reappear is "3)".
Tapping the review button 395 places the tablet computer 100 (FIG.
1) in review mode as shown in FIG. 16. The physician or medical
specialist does not need to learn a new set of commands to operate
the review mode. The physician or medical specialist has a familiar
screen display with the series of buttons 210. The physician or
medical specialist can move to other screen displays through the
use of the vertical tabs 202, or horizontal tabs 204.
Movement within the patient data in the lower window 200 is done
through the physician's or medical specialist's choice of the page
forward 332, page back 334, flag jump right 328, flag jump left
330, or through the use of the hand tool icon 338 found on the pen
tool icon bar 336.
In accordance with the present invention, the physician or medical
specialist may add new voice annotations, ink annotations, or
footnote annotations. The new annotations will be marked by
additional flags in the compressed buffer overview 306. The
physician or medical specialist may erase existing annotations by
using the pen 102 (FIG. 1) as the eraser tool after tapping an
eraser tool icon 398.
In accordance with the present invention, during the review of
saved data, a transcribe button 400, an undo button 402, and an end
review button 404 preferably appear on the display screen in the
review mode. The undo button 402 deletes all modifications made to
that particular review screen display during the review of saved
data. Tapping the undo button 402 does not affect changes made to
other screen displays during the review session. Tapping the end
review button 404 terminates the review session and stores all
changes to the existing set of saved data.
Tapping the end review button 404 returns the display to the save
catalog menu (as shown in FIG. 15). Subsequent review of this same
saved data set will start at the screen display that the physician
or medical specialist was viewing when the physician or medical
specialist tapped the end review button 404. Subsequent reviews
will show the annotations as modified during prior reviews of the
same saved data.
Tapping the transcribe button 400 causes a transcription menu 406
and a text window 408 to appear on the display screen as shown in
FIG. 17. A list of all voice annotations associated with the data
set preferably is displayed in the transcription menu 406. A voice
annotation 410 preferably is identified by a flag letter 412
(preferably the letter of the flag associated with the voice
annotation), a date and time of recording 414 (preferably the date
and time at which the voice annotation 410 was created), and a
transcription indicator 416. The transcription indicator 416
preferably is either "Y" or "N". As shown in FIG. 17, the
transcription indicator 416 of the voice annotation 410 is "N",
meaning that the voice annotation 410 has not been transcribed. A
"Y" preferably is used to indicate that a voice annotation has been
transcribed.
Voice annotations can be transcribed by the person who created the
voice annotation (e.g., physician or medical specialist) or by any
other appropriate person. A voice annotation is selected for
transcription by tapping a transcribe button 418 and then tapping
the voice annotation. In this case, the medical specialist has
selected the voice annotation 410 for transcription. Because the
voice annotation 410 has not been transcribed, no text appears in
the text window 408. (If the voice annotation 410 had been
partially or completely transcribed (not shown), the transcribed
text preferably would appear in the text window 408.) A selection
label 420 preferably informs the medical specialist which voice
annotation has been selected by displaying a flag letter 422 and a
date and time of recording 424.
A play button 426, a stop button 428, a fast-forward button 430, a
rewind button 432, and a restart button 434 preferably are provided
so that the medical specialist can listen to the voice annotation
410. The medical specialist taps the play button 426 to begin
playback of the voice annotation 410, and taps the stop button 428
to stop playback of the annotation. If the medical specialist taps
the play button 426 after tapping the stop button 428, the voice
annotation 410 preferably is played back beginning at the point
where playback was previously stopped. Tapping the restart button
434 preferably causes the voice annotation 410 to playback from the
beginning of the voice annotation 410 rather than from the point at
which the stop button 428 was last pressed. The medical specialist
preferably can tap the restart button 434 anytime during playback
in order to return to the beginning of the voice annotation 410.
The fast-forward button 430 causes the playback to skip forward in
the voice annotation 410, while the rewind button 432 causes the
playback to skip back in the voice annotation 410.
The medical specialist preferably converts the voice annotation 410
into text using the keyboard 188 (FIG. 3) of the base station 154
(FIG. 3). The tablet computer 100 preferably is plugged into the
base station 154 (FIG. 3) during transcription since the tablet
computer 100 preferably does not have a keyboard. In an alternative
embodiment (not shown), the tablet computer is provided with a
keyboard jack into which a keyboard is plugged during the
transcription process.
FIG. 18 shows the text window 408 with text 436 after the medical
specialist has transcribed the voice annotation 410. The text
window 408 preferably is programmed with a conventional
word-processor, many of which are well known in the art, to permit
the medical specialist to edit the text 436 in the text window 408.
When a keyboard is used to enter the transcription, function keys
on the keyboard should preferably be mapped to the audio playback
controls to reduce hand movement back and forth between the
keyboard and the display. The medical specialist preferably saves
the transcribed text by tapping a save button 438.
Tapping a delete button 440 preferably deletes the voice data. The
medical specialist preferably can delete the voice data after it
has been transcribed in order to conserve memory. A confirm cycle
preferably is provided in order to prevent the accidental deletion
of voice data. In an alternative embodiment (not shown), the delete
button 440 preferably is omitted in order to ensure that voice data
is not accidentally deleted. This embodiment may be preferable when
sufficient memory is available to store numerous voice
annotations.
If the medical specialist wishes to transcribe a different voice
annotation, he or she taps the desired voice annotation in the
transcription menu 406 and then taps the transcribe button 418.
Selecting a new voice annotation preferably causes the voice
annotation currently displayed in the text window 408 to be saved
and the newly selected voice annotation to appear in the text
window 408. A confirm cycle can be provided before the previously
displayed voice annotation is saved.
The medical specialist taps a done button 442 in order to exit the
transcription display screen and return to the saved catalog menu
(FIG. 15). Any voice annotation appearing in the text window 408
when the done button 442 is pressed preferably is automatically
saved before returning to the saved catalog menu (FIG. 15). A
confirm cycle can be provided before the displayed voice annotation
is saved.
Referring back to FIG. 15, the physician or medical specialist
exits the save catalog menu by tapping a close button 444. Tapping
the close button 444 deletes all sets of saved data currently
marked with "DEL".
FIG. 19 shows the display screen in the review mode after the voice
annotation has been transcribed. A modified voice annotation marker
446 appears in the lower window 200. The letter "T" (in addition to
the letter "D") preferably appears within the modified voice
annotation marker 446 in order to indicate that the voice
annotation has been transcribed.
When the user selects the modified voice annotation marker 446, the
text of the voice annotation preferably appears in a text window
448 as shown in FIG. 20. Once the voice annotation has been
selected, the physician preferably can add further voice data to
the voice annotation using the control window 368. In particular,
tapping the begin recording button 370 permits the physician to
record voice data which preferably is added to the end of the
previous voice annotation, rather than replacing the previous voice
annotation. (Of course, if the previous voice annotation was
deleted after having been transcribed, then the newly recorded
voice data will be the only voice data saved.) When the physician
is finished recording the additional voice data, he or she taps the
stop recording button 372.
Tapping the playback button 374 preferably causes the voice
annotation to be played back, including any newly recorded voice
data. If the previous voice annotation was deleted after having
been transcribed, only the newly recorded voice data is played
back.
Tapping the clear button 376 preferably deletes all voice data
entered since the voice annotation was selected. That is, tapping
the clear button 376 preferably does not effect any voice data
recorded before the voice annotation marker 364 was selected for
display. A confirm cycle preferably is provided when the clear
button 376 is pressed in order to prevent the accidental deletion
of voice data. As is the case when recording a new voice
annotation, the control window 368 preferably remains displayed
after the clear button 376 is pressed.
Tapping the cancel button 378 preferably ends the display of the
transcribed voice annotation without saving the voice data recorded
while the voice annotation marker 364 was selected. Previously
recorded voice data preferably is not effected by tapping the
cancel button 378. A confirm cycle preferably is provided when the
cancel button 378 is pressed in order to prevent the accidental
deletion of voice data.
Tapping the done button 380 preferably ends the display of the
transcribed voice data and preferably saves any additional voice
data that was recorded while the voice annotation marker 364 was
selected.
In an alternative embodiment, during the transcription of a voice
annotation, the display screens shown in FIGS. 15-18 preferably are
displayed on the display screen 175 (FIG. 3) of the base computer
154 (FIG. 3), rather than on the display screen of the tablet
computer 100. Using the display screen 175 (FIG. 3) of the base
computer 154 (FIG. 3) may be more convenient than using the display
screen of the tablet computer 100 because the keyboard 188 (FIG. 3)
of the base computer 154 (FIG. 3) preferably is used to transcribe
a voice annotation. In this embodiment, rather than using the
digitizer pen 102 (FIG. 1) to select items on the display screen,
the physician or medical specialist preferably uses a "mouse" or
similar such input device (not shown) to select items on the
display screen of the base computer 154 (FIG. 3). The use of such
input devices to select items on a display screen is well known to
those skilled in the art.
Another alternative embodiment of the present invention is shown in
FIG. 21. In this embodiment, the transcription of voice data is
carried out using the digitizer pen 102 (FIG. 1) rather than using
a keyboard. The elements displayed on the display screen in this
embodiment preferably are the same as those shown in FIGS. 17 and
18, and are thus labeled with the same reference numbers (except
for the ink tool icon 450, text window 452, and text 454 as
explained below). The like-numbered elements operate in the same
manner as those described above in reference to FIGS. 17 and 18 and
will not be discussed further here. After selecting the voice
annotation 410 for transcription, the medical specialist taps an
ink tool icon 450 to allow the pen 102 (FIG. 1) to write in the
text window 452. When the medical specialist is finished writing he
or she taps the ink tool icon 450 again. The medical specialist
saves handwritten text 454 by tapping the save button 438. In this
embodiment, the display screen shown in FIG. 21 is displayed on the
display screen of the tablet computer 100 so that the user can
write with the digitizer pen 102 (FIG. 1).
FIG. 22 shows the display of the transcribed voice annotation in
the review mode (i.e., similar to the display screen shown FIG.
20). In this embodiment, the text window 488 displays the
handwritten text 454 in the lower display window 200.
FIG. 23 shows an illustrative sequence of steps for recording and
transcribing a voice annotation in accordance with the present
invention. These steps have already been described in detail, and
so the following discussion simply summarizes the detailed
processing steps provided above. At step 456 the user designates a
connection point of the patient data scroll. At step 458 the user
is asked to confirm the connection point designated at step 456.
(Step 458 can be omitted, especially in the case of experienced
users.) At step 460 the user records the voice annotation. At step
462 a voice annotation marker appears on the display screen of the
tablet computer 100 (FIG. 1) at a location corresponding to the
connection point designated at step 456. At step 464, an
appropriate medical specialist transcribes the voice annotation. At
step 468 the text of the transcribed voice annotation is displayed
on the display screen of the tablet computer 100 (FIG. 1).
The print options preferably available when using tablet computer
100 are described in detail in the aforementioned '367 application
and will not be discussed further here. Voice annotations are not
printed, of course, because they comprise sounds rather than
printed matter. However, once a voice annotation is transcribed,
the transcribed annotation can be printed in a manner substantially
similar to the manner in which ink annotations are printed as
described in the aforementioned '367 applicatation.
Thus, methods and apparatus for annotating data in an implantable
device programmer using digitally recorded sound have been
provided. One skilled in the art will appreciate that the present
invention can be practiced by other than the described embodiments,
which are presented for purposes of illustration and not of
limitation, and the present invention is limited only by the claims
which follow.
* * * * *